Friday, August 26, 2005

HEALTH: Sagam Community Hospital: personal observations from the doctor in charge

Dr Manasseh Onyimbi, MD. MPH. CTM - will be leaving Sagam Community Hospital shortly to pursue post graduate training in Internal Medicine in South Africa. He shares his observations on the hospital and the services provided. The RSA community will miss him dearly and want to convey sincere gratitude for his dedication and selfless service and wish him the best in his studies.

(View of Sagam Community Hospital along Luanda-Siaya road)

With very noble intention and initiative the Sagam Community hospital was established less than a decade ago, in memory of the late pioneer Educationist, Mzee Gordon Rogo, who taught most of the national leaders of our time, at Komullo School (now St. Stephens Cathedral in Kisumu).

The institution is strategically placed at a most accessible point along the Kisumu- Luanda-Siaya main road, hence, communication is excellent at all times and seasons. The geographical location of the hospital within the tranquil and pacified rural environment and set up, backed up by natural canopy with all its freshness, befits its carefully chosen name - Gordon Rogo Memorial Sagam Community Hospital. All these factors cummulatively endorse its idealism as a perfect health care and provision center.

The potential of this hospital for all purposes, is enormous and is yet to be fully tapped/exploited for the improvement of health of the community and groups from near and far. While the Bamako Initiative and Primary Health Care (health for all by the year 2000) endorsed by all African governments more than a decade ago still remains merely a political rhetoric, the popular Sagam Community Hospital was already in place and has been ahead of them in the actual/practical purpose, providing quality health care to the people of Siaya, Vihiga, Bondo districts and beyond. The hospital runs a very good outreach and home-based care program that is doing wonders for the community.

What is needed now to revamp and expand the impact of the hospital is aggressive and professionally guided marketing all over the region far and near, in order to enable a wider spectrum of people to know the existence of this unique institution and the availability of essential facilities/services rendered.

In this context, more focus focus should be placed on schools, colleges, non-governmental organizations, parastatals, organized groups and individuals who need good health related services. The marketing should be a continuous process with deliberate and consistent follow-up. Constant reassurance of the clients have to be part of the game. Affiliation with other related institutions like K-MET and Nairobi Women's Hospital is in the right direction and is to be encouraged.

Strong financial base
Running a hospital in a rural area with high levels poverty is a challenge and high risk that most investors are unwilling to take. It is therefore a miracle that Sagam Hospital has survived, independent of any external support, when even mission hospitals such as Maseno and Kima are collapsing. But a strong financial base is still needed to enhance comfortable hiring/employment and retention of competent/well trained staff of all cadres, including Resident Doctor, Administrator (an honest one), Clinical Officers, Nursing Staff, other supportive and subordinate staff. With such resourceful and qualified manpower for this very important institution, it will be possible to establish a more effective administrative structure with emphasis on dedication, honesty and sense of responsibility at all the times.

Departmental heads should be persons with full sense of responsibility and accountability in all that they are entrusted with, and/or put under their jurisdiction. So far both the outpatient and inpatient wings have been functioning reasonably well (except for inadequate staff at times). The wards are clean and well partitioned but the introduction of treated bed nets should be speeded up, this area being a malaria endemic zone. Pharmacy also requires round the clock qualified staff with certificate or diploma level training and who know and understand the necessity and good use of drugs. They are not easy to attract to rural areas as urban employment is more attractive

The surgical theatre is generally very well equipped and has been serving well. The surgeons attached to the hospital i.e. Dr. Willis Oyieko and Dr. Francis Otieno, are satisfied with the equipment and there is no reason to complain.

Nursing care is quite good except that staff will need to be increased in number as the planned marketing translates to increased patient flow.

The laboratory has been able to provide the basic diagnostic services. The only set back has been lack of the QBC micro-tubes for detailed hematological analyses. The problem is partly national as the tubes are difficult to access in the country. Alternative technology (with added costs) should be considered.

Security is an institutional nightmare all over the country and Sagam is no exception. Security at the gates should be improved and the sentries/watchmen encouraged to be more vigilant in order to forestall petty thefts from the hospital, as was reported of blood pressure machines from outpatient department twice recently.

Transport is a necessity and the Land Rover ambulance is useful for the rough terrain. It will make a great positive difference if the hospital could have another light engine, easy maintenance vehicle for ready use in emergencies between the hospital and the surrounding towns of Kisumu and Siaya.

The Admission/Examination room, being the first institutional image, now requires some improvement or relocation in order to have more space, lighting and ventilation, especially due to increasing patient load.

The mortuary is the best in the region and has been serving the community quite well. Refrigeration works well and the facility continues to be full, receiving bodies from as far as Vihiga and Bondo Districts. Its entry gate should have a permanent watchman on a 24-hour basis.

The kitchen service has been quite satisfactory.
Cleanliness of all areas of the hospital, compound and within the buildings has been quite good and should be maintained.

The hospital library is one of the most well equipped information centers in this region, with very rare and valuable medical literature never to be found in most of our local University libraries. It is important that the available books, journals, and other publications therein are guarded and jealously preserved.

As the hospital grows, it's administrative structure needs to be deliberately restructured to cope with the changes. Sagam Community Hospital favorably compares with any other well-equipped mission, district or sub-district hospital in this country. It is therefore prudent that the management team always be headed by an experienced and competent Resident Medical Officer, well remunerated to retain and motivate him/her. Next in the hierarchy should be a trained/experienced hospital administrator, followed by the Nursing Officer in charge. These people are not easy to obtain in a rural setting but no effort should be spared to get them. The hospital is currently dealing with very enlightened patients and their relatives, who prefer to interact with highly placed authority in the institution when addressing all matters of their concern (most of the time)

There are some adjustments in management that need to be made. I have noted with concern how hundreds of working hours per week, which should be used for productive/positive marketing of the hospital, are wasted in the name of daily management meetings. I propose weekly constructive/purposeful meetings. Emergencies can be addressed whenever they crop up.

Overall, it has been a great pleasure and priviledge to serve this rural institution. It has been a joy interacting with the kind and friendly people of Gem (Jo-Odera Akango) and the adjoining locations within Siaya District being the catchment areas of Sagam community Hospital. Indeed most of them will realize my departure with surprise and a sense of loss. They should, however be reassured that the end of the earth is yet to come and I still hope to assist them in future, God willing.

I am optimistic about this hospital and its mission and will maintain contact and continue offering constructive advice.

1 comment:

Blue Cross of California said...

Interesting to see health for all was endorsed by the government. Health care is a great importance and I hope everyone will receive coverage.